Prospective controlled studies performed at this hospital and elsewhere have shown that prophylactic portacaval anastomosis (PCA) does not increase survival, although it does virtually eliminate variceal hemorrhage as a cause of death. The mortality and duration of survival is practically identical in patients with and without shunts. There is, however, an increased occurrence of death in shunted patients due largely to portal systemic encephalopathy and to delayed hepatic failure. These complications have been attributed for circumstantial reasons to extensive portal systemic shunting and to the interruption of the portal-venous flow to the liver. Several new procedures, based on distal splenorenal shunt (SRS), have been designed both to decompress the portal-venous system and to avoid these complications. Reports by Warren (Ann Surg 166: 437, 1967), Britton (Surgery 67: 104, 1970) suggest that they do. So far, post-shunt encephalopathy and hepatic failure have been observed. We propose to perform a controlled comparison of PCA vs distal SRS. Cirrhotic patients who survive hemorrhage from varices will be randomized by sealed envelope to have either PCA (end-to-side, side-to-side or mesocaval) or distal SRS (end-to-side, side-to-side with proximal splenic vein ligation) and coronary vein ligation. Preoperative studies will include arteriography to visualize portal system and hepatic vein catheterization to assess pressure and hepatic vein as well as anatomy of renal vein and inferior vena cava. LFT, GTT, and EEG will be performed preop, postop and periodically thereafter. Venous angiography will be performed 3 months post-operatively. It is estimated that 4 or 6 patients will be admitted annually to the study, which will continue for 3 years. (The same protocol will be in use at the Lemuel Shattuck Hospital in Boston by Drs. N. Grace, R. Resnick and W. McDermott. They estimate 8 admissions to the study per year).